EXAM #3 Flashcards
(69 cards)
1
Q
Benign cell growth
A
Harmless.
Does not usually require intervention
2
Q
Malignant cell growth
A
Indicates cancer
Serious, can lead to death w/o intervention
3
Q
Hypertrophy
A
Cell growth increase in tissue size (LARGER CELLt)
4
Q
Hyperplasia
A
Increase in tissue size by mass. DOUBBBLLEEE THEEE AMMMOUNNT OFF TISSUUEEE.
5
Q
Features of malignant (CANCER) cells.
A
Anaplasia(poor cellular differentiation) Large nuclear-to-cytoplasmic ratio Specific functions lost Loose adherence Migration (metastasis) No contact inhibition Rapid or continuous cell division Abnormal chromosomes (aneuploidy)
6
Q
Cancer development
A
Carcinogenesis/oncogenesis
7
Q
Primary tumor
A
Identified by the tissue from which it arose from. PARNET TISSUE.
8
Q
Secondary tissue (METASTATIC)
A
Cancer cells move from primary location and may have additional tumors.
9
Q
The four steps of Metastasis. STEP ONE.
A
MALIGNANT TRANSFORMATION: some normal cuboidal cells have undergone malignant transformation and have divided enough times to form a tumorous area within the cuboidal epithelium.
10
Q
Steps of metastasis. STEP TWO.
A
TUMOR VASCULARIZATION: cancer cells secrete tumor angiogenesis factor (TAF) stimulating the blood vessels to bud and form new channels that grow into the tumor.
11
Q
Steps of metastasis. STEP THREE.
A
BLOOD VESSEL PENETRATION: cancer cells have broken of from the main tumor. Enzymes on the surface of the tumor cells make holes in the blood vessels, allowing the cancer cells to enter the blood vessels and travel around the body.
12
Q
Steps of metastasis. STEP FOUR.
A
ARREST AND INVASION: cancer cells clump in the blood vessel walls and invade new tissue areas. If the new tissue areas have the right conditions to support continued growth of cancer cells, new tumors (metastatic tumors) will form at this sight.
13
Q
Cancer classification(GRADING&PLOIDY)
A
GRADING: varying in their aggressiveness and sensitivity to treatment. Gx(can’t determine)G1(less severe)-G4(more severe)
POLIDY: is the description of cancer cells by chromosome number and appearance. Some cancer cells gain or lose whole chromosomes and may have structural abnormalities of the remaining chromosomes, a condition called aneuploidy. The degree of aneuploidy usually increases with the degree of malignancy.
14
Q
TNM
A
Tumor, node, metastasis (TNM) system is used to describe the
anatomic extent of cancers.
PRIMARY TUMOR
REGIONAL LYMPH NODES
DISTANT METASTASIS
15
Q
Tx
A
Primary tumor cannot be assessed.
16
Q
T0
A
No evidence of primary tumor.
17
Q
Tis
A
Carcinoma in situ.
18
Q
T1 T2 T3 T4
A
Increasing size and or local extent of primary tumor.
19
Q
Nx
A
Regional lymph nodes cannot be assessed.
20
Q
N0
A
No regional lymph node metastasis
21
Q
N1 N2 N3
A
Increasing involvement of regional lymph nodes.
22
Q
Mx
A
Presence of distant metastasis cannot be assessed
23
Q
M0
A
No distant metastasis
24
Q
M1
A
Distant metastasis
25
Doubling Time
the amount of time it takes for a tumor to double in size
26
Mitotic index
the percentage of actively dividing cells within a tumor
27
What factors influence cancer development
exposure to carcinogens, genetic predisposition, and
immune function
28
Oncogene activation
the main mechanism of carcinogenesis regardless
of the specific cause.
Oncogenes are not abnormal genes but are part of every cell's normal makeup. Oncogenes become a problem only if they are overexpressed as a result of exposure to carcinogenic agents or events with loss of cellular regulation. Both external and personal factors can activate oncogenes.
29
Chemical carcinogenesis
can occur from exposures to many known
chemicals, drugs, and other products used in everyday life
30
Physical carcinogenesis
from physical agents or events also causes cancer
by DNA damage. Two physical agents that are known to cause cancer are radiation and chronic irritation.
31
Viral Carcinogenesis
occurs when viruses infect body cells and break DNA strands. Viruses then insert their own genetic material into the human DNA.
32
oncoviruses
Viruses that cause cancer.
33
Dietary factors that cause cancer
are poorly understood although dietary practices are suspected to alter cancer risk. Suspected dietary factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes,
flavorings, sweeteners) may have cancer-promoting effects.
34
Personal factors that cause cancer
including immune function, age, and genetic risk, also
affect whether a person is likely to develop cancer
35
Primary Cancer Prevention
is the use of strategies to prevent the actual occurrence of cancer. This type of cancer prevention is most effective when there is a known cause for a cancer type.
36
Primary cancer prevention interventions
* Avoidance of known or potential carcinogens (use sun screen)
* Modifying associated factors appears to have a positive influence in reducing cancer risk (alcohol/ diet)
* Removal of “at risk” tissues reduces cancer risk for a person who has a known high risk for developing a specific type of cancer (moles)
* Chemoprevention is a strategy that uses drugs, chemicals, natural
nutrients, or other substances to disrupt one or more steps important to cancer development (aspirin colon cancer)
* Vaccination (HPV)
37
Secondary Cancer Prevention
SCREENING
| Mammograms/Colonoscopy/
38
Metastasis From Breast cancer
Bone
Lung
Liver
Brain
39
Metastasis from lung cancer
```
Brain
Bone
Liver
Lymph nodes
Pancrease
```
40
Metastasis from colorectal Cancer
Liver
Lymph Nodes
Adjacent structures
41
Metastasis from prostate cancer
Bone (especially spine and legs)
| Pelvic nodes
42
Melanoma
GI tract
Lymph nodes
Lung
Brain
43
Primary Brain Cancer
Central Nervous System
44
What do advanced cancers often cause?
Reduced immune and blood producing function
Altered GI structure and function
Motor and sensory deficits
Decreased respiratory function
45
Teletherapy
Delivered from a source outside of the patient.
Because the source is external, the patient is not radioactive and is not hazardous to others.
46
Brachytherapy
Brachytherapy means “short” (close) therapy. The radiation source comes into direct, continuous contact with the tumor for a specific time period.
Therefore the patient emits radiation for a period of time and is a potential hazard to others.
47
Care of patients with sealed implants of radioactive sources
Assign the patient to a private room with a private bath.
• Place a “Caution: Radioactive Material” sign on the door of the patient's room.
• If portable lead shields are used, place them between the patient and the door.
• Keep the door to the patient's room closed as much as possible.
• Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure.
• Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do patient).
• If you are attempting to conceive, do not perform direct patient care
regardless of whether you are male or female.
• Pregnant nurses should not care for these patients; do not allow
pregnant women or children younger than 16 years to visit.
• Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source.
• Never touch the radioactive source with bare hands. In the rare
instance that it is dislodged, use a long-handled forceps to retrieve it.
Deposit the radioactive source in the lead container kept in the
patient's room.
• Save all dressings and bed linens in the patient's room until after the
radioactive source is removed. After the source is removed, dispose of
dressings and linens in the usual manner. Other equipment can be
removed from the room at any time without special precautions and
does not pose a hazard to other people.
48
Skin protection during radiation therapy
• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team.
• Use your hand rather than a washcloth when cleansing the therapy site to be gentler.
• Rinse soap thoroughly from your skin.
• If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them.
• Dry the irradiated area with patting motions rather than rubbing
motions; use a clean, soft towel or cloth.
• Use only powders, ointments, lotions, or creams on your skin at the
radiation site that are prescribed by the radiation oncology
department.
• Wear soft clothing over the skin at the radiation site.
• Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site.
• Avoid exposure of the irradiated area to the sun: Protect this area by wearing clothing over it. Try to go outdoors in the early morning or evening to avoid the more intense sun rays. When outdoors, stay under awnings, umbrellas, and other forms of
shade during the times when the sun's rays are most intense (10 am
to 7 pm).
• Avoid heat exposure.
Avoid sun exposure for AT LEAST 1 year after completion of eradication therapy.
49
Seeds or needles VS other implants
Some devices (e.g.,seeds or needles) can be placed into the tumor and stay in place by themselves. Seeds are so small and the half-life of the isotope so short that this device is permanently left in place (often for prostate cancer) and, over time, completely loses its radioactivity. Other devices are removed and reused in other patients.
50
Chemotherapy
Chemotherapy, the treatment of cancer with chemical agents, is used to cure and to increase survival time. It has some selectivity for killing cancer cells over normal cells. This killing effect on cancer cells is related to the ability of chemotherapy to damage DNA and interfere with cell division. Tumors with rapid growth are often more sensitive to chemotherapy.
51
Routes of chemotherapy
IV route is the most common.
For specific cancer types, the chemotherapy may be infused or
instilled into a body cavity.
The intrathecal route delivers drugs into the spinal canal.
Intraventricular route delivers drugs directly into the ventricles of the brain.
Intraperitoneal instillations place the drugs within the abdominal cavity, most often for ovarian cancer.
Intravesicular route- for bladder.
Topical preparation for skin lesions.
Intra-arterial infusions may be used to deliver a higher dose
locally. For examples, with liver tumors, an interventional radiologist
places a catheter into the artery supplying the liver tumor.
52
Guidelines with chemo drugs.
Anyone preparing, giving, or disposing of chemotherapy drugs or handling excreta from patients within 48 hours of receiving IV chemotherapy must use extreme caution and wear personal protective equipment (PPE). Such equipment includes eye protection,
masks, double gloves or “chemo” gloves, and gown. The Occupational Safety and Health Administration (OSHA) and the Oncology Nursing Society (ONS) have established these practice guidelines and protective standards.
53
Side effects of Chemotherapy drugs
The suppressive effects on the bone marrow blood-
forming cells cause:
anemia (decreased numbers of red blood cells and hemoglobin) neutropenia (decreased numbers of white blood cells leading to immunosuppression)
thrombocytopenia (decreased numbers of platelets). Common distressing side effects include:
nausea and vomiting,
alopecia (hair loss),
mucositis (open sores on mucous membranes),
many skin changes,
anxiety, sleep disturbance,
altered bowel elimination,
changes in cognitive function.
The emotional impact of these side effects is referred to as cancer therapy symptom distress, which can vary from patient to patient.
54
Bone marrow suppression
In addition to killing cancer cells, chemotherapy also destroys circulating blood cells and reduces replacement of these cells by suppressing bone marrow function, also known as myelosuppression. The numbers of all circulating leukocytes, erythrocytes, and platelets are decreased. Reduced leukocyte numbers, especially neutropenia, greatly increase the risk for
infection. Decreased erythrocytes and platelets cause hypoxia, fatigue, and impaired clotting leading to an increased tendency to bleed.
55
Hormone therapy
decreasing the amount of these hormones available to hormone-sensitive tumors can slow the cancer growth rate.
Hormonal manipulation includes steroids, steroid analogues, and
enzyme inhibitors (aromatase inhibitors, gonadotropin-releasing
hormone analogues, antiandrogens, and antiestrogens). Many of these agents are used to block receptors and thus prevent the cancer cells from receiving normal hormonal growth stimulation
56
Side effects of hormone therapy
```
masculinizing effects in women
Feminizing effects in men
Fluid retention
Acne
Hypercalcemia
Liver dysfunction
Venous thromboembolism
```
57
Oncologic emergencies
Sepsis, or septicemia, is a condition in which organisms enter the bloodstream (bloodstream infection [BSI]) and can result in septic shock,a life-threatening condition
Disseminated intravascular coagulation (DIC) is a problem with the
blood-clotting process. DIC is triggered by many severe illnesses,including cancer. Extensive, abnormal clotting occurs throughout the small blood vessels.
of patients with DIC. This widespread clotting depletes the existing
clotting factors and platelets. As this happens, extensive bleeding occurs. Bleeding from many sites is the most common problem and ranges from minimal to fatal hemorrhage.
SIADH, water is reabsorbed in excess by the kidney and put into systemic circulation. The retained water dilutes blood sodium levels. Mild manifestations include weakness, muscle cramps, loss of appetite, and fatigue. Serum sodium levels range from 115 to 120 mEq/L or lower(normal range is 135 to 145 mEq/L). With greater fluid retention, weight gain, nervous system changes, personality changes, confusion, and extreme muscle weakness occur. As the sodium level drops toward 110 mEq/L, seizures, coma, and death may follow depending on how rapidly the sodium value is lowered. Patient safety includes preventing fluid overload from becoming worse, leading to pulmonary edema and heart failure
Spinal cord compression (SCC) and damage occur either when a tumor directly enters the spinal cord or the spinal column or when the
vertebrae collapse from tumor degradation of the bone.Assess for neurologic changes, including back pain, muscle weakness or a sensation of heaviness in the arms or legs, numbness or tingling in the hands or feet, inability to distinguish hot and cold, and an unsteady gait. Constipation/incontinence.
Hypercalcemia (increased serum calcium level) occurs in up to a third of patients with cancer. Common manifestations include skeletal pain, kidney stones, abdominal discomfort, and altered cognition. Additional manifestations include fatigue, loss of appetite, nausea, vomiting, constipation, and increased urine output. More serious problems include severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, and electrocardiographic (ECG) changes. Oral hydration and NS IV fluids.
Super Vena Cava Syndrome: The superior vena cava (SVC), which returns all blood from the cranial, neck, and upper extremity vasculature to the heart, has thin walls, and compression or obstruction by tumor growth or by clots in the vessel leads to congestion of the blood. Edema in face.
In tumor lysis syndrome (TLS), large numbers of tumor cells are
destroyed rapidly. Their intracellular contents, including potassium and purines (DNA components), are released into the bloodstream faster than the body can eliminate them. HYDRATION. 3000-5000ml day before and three days after.
58
The hematologic system includes?
blood, blood cells, lymph, and
organs involved with blood formation or blood storage. This system is
important for oxygenation (gas exchange) and tissue perfusion because the
blood is the oxygen delivery system
59
Bone marrow
Bone marrow is responsible for blood formation. It produces red blood cells (RBCs, erythrocytes), white blood cells (WBCs, leukocytes), and platelets. Bone marrow also is involved in the immune responses.
60
Blood components
Blood is composed of plasma and cells. Plasma is an extracellular fluid. It is similar to the interstitial fluid found between tissue cells, but plasma contains much more protein. The three major types of plasma proteins are albumin, globulins, and fibrinogen.
Albumin maintains the osmotic pressure of the blood, preventing the
plasma from leaking into the tissues.
Globulins have many functions, such as transporting other substances and, as antibodies, protecting the body against infection.
Fibrinogen is activated to form fibrin, which is critical in the blood clotting process.
61
Red blood cells
erythrocytes!! are the largest proportion of blood cells.
Mature RBCs have no nucleus and have a biconcave disk shape.
normal range is from 4,200,000 to 6,100,000/mm3
62
Hemoglobin
The RBCs produce hemoglobin (Hgb). Each normal mature RBC
contains hundreds of thousands of hemoglobin molecules. Each hemoglobin molecule needs iron to be able to transport up to four molecules of oxygen. Therefore iron is an essential part of hemoglobin. The most important feature of hemoglobin is its ability to combine loosely with oxygen. Only a small drop in tissue oxygen levels increases the transfer of oxygen from hemoglobin to tissues, known as oxygen dissociation.
63
Red blood cell production
erythropoiesis.
must be properly balanced with RBC
destruction or loss. When balanced, this process helps tissue perfusion by ensuring adequate delivery of oxygen. When
tissue oxygen is less than normal (hypoxia), the kidney releases more
erythropoietin, which then increases RBC production in the bone
marrow. When tissue oxygen is normal or high, erythropoietin levels fall, slowing RBC production.
Many substances are needed to form hemoglobin and RBCs, including iron, vitamin B12, folic acid, copper, pyridoxine, cobalt, and nickel. A lack of any of these substances can lead to anemia, which results in unmet tissue oxygen needs because of a reduction in the number or function of RBCs.
64
White blood cells
White blood cells (WBCs, leukocytes) also are formed in the bone marrow. The many types of WBCs all have specialized functions that provide protection through inflammation and immunity.
65
Platelets
Platelets are the third type of blood cells. They are the smallest blood cells, formed in the bone marrow from megakaryocyte precursor cells. When activated, platelets stick to injured blood vessel walls and form platelet plugs that can stop the flow of blood at the injured site. They also produce substances important to blood clotting and aggregate (clump together) to perform most of their functions. Platelets help keep small blood vessels intact by initiating repair after damage.
66
Production of platelets is controlled by what?
Production of platelets is controlled by the growth factor
thrombopoietin. After platelets leave the bone marrow, they are stored in the spleen and then released slowly to meet the body's needs. Normally, 80% of platelets circulate and 20% are stored in the spleen.
67
Organs for blood production.
The spleen and liver are important accessory organs for blood
production. They help regulate the growth of blood cells and form factors that ensure proper blood clotting.
The spleen destroys old or imperfect RBCs, breaks down the
hemoglobin released from these destroyed cells, stores platelets, and
filters antigens.
The liver produces prothrombin and other blood clotting factors. Also,
proper liver function is important in forming vitamin K in the intestinal
tract. (Vitamin K is needed to produce clotting factors VII, IX, and X and prothrombin.) Large amounts of whole blood and blood cells can be stored in the liver. The liver also stores extra iron within the protein
ferritin.
68
Homeostasis
Hemostasis is the multi-stepped process of controlled blood clotting. It results in localized blood clotting in damaged blood vessels to prevent excessive blood loss while blood continues to perfuse all other areas. This complex function balances blood clotting actions with anti-clotting actions. When injury occurs, hemostasis starts the formation of a platelet plug and continues with a series of steps that eventually cause the formation of a fibrin clot.
69
Fibrinolysis
Fibrinolysis is the process that dissolves fibrin clot edges with
special enzymes. The process starts by activating plasminogen to plasmin. Plasmin, an active enzyme, then digests fibrin, fibrinogen,and prothrombin, controlling the size of the fibrin clot.
